CND Thematic Discussions // Session 8 – High transmission of HIV, HCV and other blood-borne diseases associated with drug use

Presenter 1, UNODC: Thank you, Mr. Chair, excellencies, ladies, and gentlemen. I will briefly discuss the lessons learned in the actual UNODC Partnership Project addressing drug use issues in Afghanistan amid the continuing humanitarian crisis. The project received funding support from the European Union for the implementation period 2023 to 2026. Addressing existing fragilities, including those in healthcare and drug prevention and treatment, the project aims to establish comprehensive drug treatment services. It leverages the expertise of UNODC and the Period Show along with the implementing NGO, addressing critical gaps in a context where rounding up and forced treatment of people who use drugs by the de facto authorities is escalating. The project covers 13 provinces out of 34 in Afghanistan, providing a comprehensive service package ranging from supporting drug treatment centers to community-based services. Despite challenges, the de facto authorities have shown interest in addressing drug use issues, providing common ground for collaboration with the international community. The partnership project aims to capitalize on this interest to expand and sustain programs nationwide by demonstrating and advocating with locally generated evidence. In the context of a drastic reduction in international funding post-August 21, the Ministry of Public Health-run drug treatment centers are partially operational with questionable quality due to a lack of resources and capacity. External support is crucial to continue and expand these programs. Drug demand reduction often gets overlooked amid competing needs in the humanitarian crisis. Continuous advocacy is crucial, even with humanitarian partners. In Afghanistan, continuous investment in treatment is essential, along with cross-sectoral engagement for integrated approaches. Besides the partnership project with UNODC, collaborations extend to partners like UNAIDS, UNFPA, IOM, and others to address diverse needs for drug treatment and reintegration services. The results have been encouraging, and I conclude my remarks here. Thank you for your attention.

Presenter 2, UNODC: Today we will dive into the discussions about demand reduction and providing insights into the CHAMPS program. This initiative addresses the population not currently using drugs, encompassing users, those contemplating use, and those at the beginning stages. Primarily focusing on individuals below 18 years of age, the aim is to prevent or, at the very least, delay the onset of substance use. The program emphasizes evidence-based interventions that start as early as infancy and childhood. It recognizes the effectiveness of interventions documented to work during a child’s development, targeting social, emotional, and cognitive competencies. Resolution 65/4, initiated in 2002, highlights the importance of early prevention, acknowledging its multidimensional impact on various negative social and health outcomes. CHAMPS seeks to amplify prevention efforts by adding interventions at different developmental stages, ensuring no child is left behind in addressing vulnerabilities. This involves collaborative partnerships among governments, private sectors, academic institutions, civil society organizations, and UN agencies. Over a five-year period, CHAMPS plans to implement its model in at least 10 countries, covering diverse geographical locations. Each wave of implementation aims to reach around 5 million children through a collaborative partnership. The program will showcase its effectiveness and return on investment in preventing substance use and promoting positive outcomes, such as reduced violence, improved mental health, and enhanced youth engagement. In conclusion, CHAMPS is an effort to create a comprehensive model for early prevention, leveraging partnerships and a holistic approach to address vulnerabilities in children. Countries interested in participating are encouraged to join this collaborative initiative and contribute to the well-being of children and adolescents. For more information, interested parties can reach out via email. Thank you for your attention, Mr. Chair.

Mexico: My question pertains to the observations made during the review process, specifically highlighting the challenges related to the coverage and availability of reliable data in the field of drug control. The inadequacy in addressing this issue over the past five years is a concern. There exist several political commitments and documents, such as documents 9/14 and 9/16, specifically addressing the matter of data collection. Regrettably, these concerns have not been adequately tackled in the revision exercise. In light of this, I would like to propose that the incoming Chairperson of the Board considers organizing a dedicated session during the upcoming professional segment to address the challenges associated with data collection. This session could include a presentation by the Secretariat, shedding light on their collaboration with both the Statistics Commission and the Statistics Division. Such an initiative would be highly beneficial for all stakeholders involved. Drawing parallels with the recent experience in Indonesia, it becomes evident that the need for clarity on responsibilities in data collection extends not only to the domain of drugs but also encompasses broader issues such as negotiations on resolutions related to data collection and corruption. Therefore, a focused discussion on this matter during a dedicated session could provide valuable insights and foster better collaboration between relevant entities.

Chair: Thank you to the delegate of Mexico – noted. Now I give the floor to Mr. Tettey.

UNODC: This morning’s discussions featured speakers sharing insights into national strategies and initiatives aimed at addressing issues, particularly related to drug-related mortality. There was a consistent emphasis on the importance of adopting a comprehensive perspective, encompassing evidence-based prevention, treatment, rehabilitation, and aftercare. Prevention services were underscored, with speakers stressing the need for effective prevention strategies that consider the specificities of populations and evolving drug market dynamics. Reference was made to the UN ODC international standards for the treatment of drug use disorders, recognized as providing valuable guidance and best practices for drug use disorder treatment services. A key point emphasized was that treatment for drug use and drug use disorders should be evidence-based and accessible to all without discrimination. Building partnerships at the local level was highlighted as a crucial aspect of these efforts. Several speakers advocated for the adoption of approaches tailored to different groups, with a specific focus on addressing the underrepresentation of certain groups, such as women, adolescents, and individuals within the criminal justice system, among those accessing and using services globally. The need to incorporate measures to mitigate the negative consequences of drug use within comprehensive drug treatment and health services was also reiterated by multiple speakers. In summary, the discussions emphasized the multifaceted nature of tackling drug-related challenges and the importance of inclusive, evidence-based approaches that consider the diverse needs of various populations. Thank you, Mr. Chair.

Chair: thank you for the summary. This afternoon’s session will focus on the rate of transmission of HIV, hepatitis C virus, and other blood-borne diseases associated with drug use. This includes discussions on drug use situations in certain countries. Presenting on this topic are representatives from the (…) Association, and the Chief of the Scientific Services Branch. Let’s begin with their presentation. They now have the floor.

UNODC: In 2021, there were an estimated 13.2 million people who inject drugs, accounting for 0.26% of the population aged 15 to 64. The highest prevalence of people who inject drugs remains in Eastern Europe and North America. Nearly half of the estimated global number resides in North America and East/Southeast Asia. Injection drug use continues to drive the spread of HIV globally, with an estimated 1.6 million people who inject drugs living with HIV in 2021. For hepatitis C, an estimated 6.6 million people who inject drugs are living with the virus worldwide in 2021, accounting for nearly half of all cases. This is 37 times higher than the prevalence of hepatitis C in the general population. Men are five times more likely than women to inject drugs, but women who inject drugs are 1.2 times more likely than men to be living with HIV. Women who use drugs, particularly stimulants, are at a higher risk of acquiring HIV due to sexual risk behaviors. Stimulant drug use is increasing globally, with drugs like methamphetamine, MDMA, ketamine, and others being used to enhance the overall drug-taking and sexual experience. This sexualized drug use, known as Chemsex, increases the risk of HIV and other sexually transmitted infections. Crowded prisons remain high-risk environments for the transmission of infectious diseases. In 2021, an estimated 11.2 million people were held in prisons. People in prison are six times more likely to be living with HIV than adults in the general population. The prevalence of HIV among people in prison has increased by 13% since 2017. Despite the availability of opioid agonist treatment (OAT) programs in 92 countries, coverage remains inadequate to prevent the transmission of HIV among people who inject drugs in both community and prison settings. Only 88 countries have at least one site for OAT in the community, and OAT availability in prison settings is less widespread. The presentation emphasizes the need for comprehensive interventions to address the challenges associated with drug use, including HIV and hepatitis C transmission, and calls for improved coverage of key interventions to prevent HIV transmission among people who inject drugs in both community and prison settings.

UNODC: It is my pleasure to provide some introductory remarks as we commemorate World AIDS Day. We recognize the importance of a community-led integrated approach to prevent and treat HIV, hepatitis C, and other blood-borne infections. I hope you had the opportunity to attend the event at lunchtime today, as presented by my colleagues. The current estimate indicates that there are 13.2 million people who inject drugs, with half of them living with hepatitis C or HIV. People who use drugs account for approximately 10% of new HIV cases, highlighting the ongoing challenge. While progress has been made, effective measures are crucial for preventing the spread of these infections. In countries with high coverage of needle exchange programs, opioid agonist therapy, and robust distribution of naloxone, the transmission of HIV is nearly zero. Technical support and advocacy efforts have contributed to the initiation of opioid therapy in Algeria, Libya, Tunisia, and the capacity building of 350 service providers and community-led organizations in 14 countries. Currently, 94 countries have opioid agonist therapy programs in place, reflecting promising progress, yet there is still much work to be done. Scaling up services globally is essential, considering the low overall coverage, with many services limited to one site or urban centers in several countries. Addressing stigma and discrimination against people who use drugs and those in prisons is critical, representing significant barriers to accessing these services. It is essential to recognize that the risk of acquiring HIV and hepatitis C among people who use drugs is not limited to opioids; the use of stimulants can also increase the risk of transmission in certain contexts. To tackle this challenge, UNODC has developed technical guidance and a comprehensive capacity-building program to support countries in implementing HIV and hepatitis prevention programs for people who use stimulant drugs. This program has been rolled out to over 1,000 service providers and community-led organizations in 20 high-priority countries. Addressing the challenge also involves substantially increasing the availability of services in prisons. In 2021, 59 countries reported opioid agonist therapy provision for people who use drugs in at least one prison, but only nine countries reported needle exchange programs in at least one prison site. Scaling up these services is essential, and UNODC is working to build the capacity of over 500 prison healthcare staff and support more than 50 prisons in 30 high-priority countries. UNODC is well-positioned to convene a wide variety of stakeholders in the HIV response, particularly law enforcement, to build their capacity in addressing HIV-related challenges among people who use drugs. The organization is committed to overcoming impediments in some countries and stands ready to continue working with its partners to support efforts in preventing and treating HIV, hepatitis C, and other blood-borne infections among people who use drugs and those in prison settings, leaving no one behind in pursuit of SDG targets. Thank you.

Chair: Floor open for questions

EU: Thank you for these presentations. It was interesting to hear that you said 92 countries now have even syringe programs and 88 opioid agonist treatment. And I was wondering how have these numbers developed over time? And what’s the background?  I would really be interested to hear if you say because, for instance, you were comparing prison population from the year 2000. We take the same kind of premium timeframe around the year 2000. How have these numbers developed over time?

Oman: My question about support, because some (…) are more technical like substitution programs… So is it in cooperation with WHO or …how to be approached for success?

UNODC: European Union – about 294 countries with at least one needle and syringe program, not 94 as previously stated. Additionally, 80 countries now have at least one opioid agonist therapy program. To provide insight into the evolution of these programs, I may not have exact numbers for the increase over the years, but I can note that there was a substantial increase around the early 2000s. More countries began adopting opioid agonist treatment programs in response to the AIDS epidemic among people who inject drugs. However, progress slowed significantly afterward, with only two countries adopting opioid agonist treatment in the last one or two years. A similar trend can be observed for needle syringe programs, where initial progress, especially through dedicated funding programs, has since slowed down in terms of increasing the number of sites and expanding the provision of needle syringe programs. I hope this provides clarification.

Responding to the question from the from the distinguished delegate from Oman. Yes in our interventions we work very closely with our colleagues from WHO in all countries where we operate. And you will need more information on how you can engage with the program directly, please drop me a line and we’ll be ready to give you some more details.

MS: So you mentioned about the opioid agonist. And my question is, are there any medicine or agonist therapy especially on acceptable opioids? And if not, are there any program or initiative to search for such new medicines? Thank you.

UNODC: In terms of producing solutions for stimulants, the goal is similar to what has been achieved with opioids. Opioids, as agonists, trigger a response, and careful management is crucial to avoid respiratory suppression. The use of antagonists like Naloxone has been effective in reversing opioid effects, especially with substances like methadone. Unfortunately, for stimulants like methamphetamines, there is ongoing research to find comparable solutions. Tomorrow, a colleague will delve into these research efforts, and I encourage you to attend. Regarding achieving the 2030 targets, it’s a significant challenge. Progress has been made, as noted in the 2019 ministerial report, but it’s acknowledged that more needs to be done. The upcoming meeting in March is aimed at evaluating and consolidating the response. The goal is to learn from successful measures implemented in various countries and, hopefully, by the 2029 meeting, be able to affirm that substantial progress has been made towards achieving the SDG targets.
Now in simple terms, prisons are not supposed to contain drugs. But they do contain drugs. And I think that is why it’s important to have all the programs in the prisons as well. We can we can take the message from prison authorities that prisoners are clean. People do not use drugs, or they are no drug use disorders. I think for those of us who got a chance to visit prisons, you realize it sometimes mirrors or even exceeds some of the problems we see in our society. So it is important to continue that way.

Chair: I see no more questions. From the floor. Thank you very much. We will begin our discussion.

EU: I would like to express my delegation’s full support for the commendable work carried out by the UNODC HIV section. We recently had the privilege of participating in a study session to mark World AIDS Day, co-sponsored by Belgium as a member of the group of friends on the prevention of HIV among people who use drugs and those in prison settings. Engaging in a rich debate with diverse community voices worldwide, we value the opportunity to continue this important discussion. Despite a substantial global decline in new HIV infections among adults over the past decade, there has been no reduction in the annual number of new HIV infections among people who inject drugs. Our global response to drugs and HIV must prioritize the health, well-being, and security of all individuals, respecting and promoting their human rights. We must actively combat stigma, recognizing that harm reduction measures are vital components of balanced drug policies, proven effective both on a multilateral and national level. Our nation has invested energy and resources to address the needs of the most vulnerable communities affected by HIV, emphasizing human rights, gender equality, key populations, health system strengthening, and sexual and reproductive health and rights. At the national level, we have developed a comprehensive HIV plan for 2020-2026, outlining guidelines for a high-quality, evidence-based, and equitable approach to HIV. This plan was collaboratively developed with all stakeholders in the field. Crucially, ongoing collaboration with organizations focusing on priority target groups, including those affected by HIV, is a cornerstone of our efforts. We applaud the theme of this year’s World AIDS Day, “Live Communities, Lead Change,” recognizing the pivotal role played by community-led organizations in delivering impact and ensuring that no one is left behind.

According to the World Drug Report, approximately 13.2 million individuals injected drugs globally in 2021. Injecting drugs poses a significantly heightened risk of HIV and hepatitis C transmission. Around 1.6 million individuals who inject drugs live with HIV. Unsafe drug injection also substantially contributes to the hepatitis C epidemic, representing 61% of newly diagnosed acute HCV infections in the European Union. Periodic updates on our progress towards achieving the 2030 Agenda for Sustainable Development consistently highlight that one transmission mode where we lag behind our goals is HIV and viral hepatitis transmission due to unsafe drug use. We must intensify efforts in prevention, easy testing access, early diagnosis, and access to evidence-based treatment for individuals with HIV and viral hepatitis. Otherwise, drug-related challenges will leave more people behind. Special efforts are needed to ensure pharmaceutical treatment and provide risk and harm reduction measures with sufficient scientific evidence supporting their effectiveness in decreasing infectious disease transmission. This includes implementing needle and syringe exchange programs tailored to national needs and legislation to assist people who inject drugs. Attention should be given to individuals in vulnerable situations, such as those in prison, compulsory care settings, people displaced by humanitarian emergencies, sex workers, individuals experiencing homelessness, and those with mental disorders. Women, in particular, face unique challenges, including limited access to treatment for women who use drugs and a higher likelihood of being introduced to drug use by male partners, increasing infection and the risk of developing drug use disorders. To counter these challenges, adopting a gender mainstreaming approach across our efforts is crucial, working towards reducing the stigma surrounding HIV and viral hepatitis. In conclusion, evidence-based information is available on cost-effective interventions that respect human rights to decrease the transmission of infectious diseases associated with drug use. Achieving favorable outcomes requires providing a comprehensive package of information and services for people who use drugs to decrease the spread of infectious diseases linked to drug use.

Brazil:  I appreciate the opportunity to emphasize the importance of addressing HIV and hepatitis C prevention policies for people who use drugs. These individuals are particularly affected by these conditions, displaying disproportionate prevalence compared to the general population. Additionally, they face vulnerabilities related to social determinants. To highlight good practices, we emphasize the following: Ensure expanded and now restricted access to HIV, HBV, and HCV testing, along with offering the hepatitis B vaccine, pre and post-exposure prophylaxis (PrEP), and treatment. Implement combination prevention strategies targeting STIs, HIV, and TB, while actively fighting stigma. Extend support for peer-to-peer and community-based projects, encompassing harm reduction, prevention, health promotion, and human rights initiatives. Take actions to eliminate vertical transmission of HIV, syphilis, HPV, and other conditions among women who use drugs. In the case of Brazil, while injectable drug use is not significant, other forms like inhaled and smoked stimulants predominate. There is an observed increase in risky sexual practices among women who use drugs, making them more vulnerable to HIV than their male counterparts. Both men and women who use drugs are at a higher risk of hepatitis C when sharing drug paraphernalia. Brazil has undertaken initiatives, ranging from the elimination of vertical transmission to encouraging prevention and expanding access to health services for pregnant women and their partners. An inter-ministerial committee has been established to combat tuberculosis and other socially determined diseases, bringing together various sectors for collaborative action. Furthermore, the government is poised to launch a national plan addressing the specific situation of people living on the streets, particularly those who use drugs.

UK: Thanks to the panel experts for their insights. In the United Kingdom, the approach to HIV associated with injecting drug use has been effective, with a lower prevalence compared to global rates. Early investments in needle and syringe programs, expanded opioid treatment, and testing have contributed to this success. Although hepatitis C has had a higher prevalence among those who inject drugs in the UK, the introduction of direct-acting antiviral medicines, negotiated by the National Health Service, has supported cost-effective rollout through different treatment services and wider healthcare. The UK is on track to achieve public health goals related to hepatitis C by 2025 and is committed to ending HIV transmissions within the country by 2030. The HIV action plan, developed as part of healthcare policy, aims to end new HIV transmission within England by 2030. In 2022, England achieved UNAIDS 95-95-95 targets nationally, with 95% of people living with HIV diagnosed, 98% of those diagnosed in treatment, and 98% of those in treatment having an undetectable viral load. As part of the HIV action plan, the National Health Service in England has introduced HIV testing in local areas with extremely high HIV prevalence. This program includes combined blood-borne viruses testing, incorporating hepatitis B and C alongside HIV testing. The program has made a substantial contribution to blood-borne virus testing, detecting over 900 previously undiagnosed HIV cases and 3,000 hepatitis viruses in the first 18 months. Recently, the government announced new research involving the expansion and evaluation of blood-borne virus opt-out testing in 47 emergency departments across England. The initiative aims to reach those who are harder to engage, such as drug users. An encouraging survey among people who inject drugs attending specialist drug services in 2022 showed that 81% reported being tested for HIV. Among those who started injecting drugs within the past three years, 70% reported having an HIV test. In England, low levels of new HIV diagnoses are believed to be associated with injecting drug use, and there has been a decline in cases in recent years. Collaborations with healthcare agencies and support partners, along with targeted data-sharing and promotion, contribute to the success of HIV testing initiatives in the country.

Thailand: With an estimated 400,000 people living with HIV in Thailand in 2020, the country recognizes the risk of HIV and hepatitis transmission through unsafe injecting practices. The 2022 civilian report indicated a prevalence of 8.2% for HIV infection, 3.3% for syphilis, 6.4% for Hepatitis B, and 38.8% for hepatitis C among injecting drug users. However, challenges persist due to unclear national policies. Despite these challenges, Thailand has made considerable progress in addressing HIV in key priority populations, including men having sex with men, prisoners, health practitioners, and people who use drugs. The country has implemented strategies such as same-day treatment initiation for newly diagnosed individuals, pre-exposure prophylaxis (PrEP), integrated harm reduction services, and hepatitis B and C screening and treatment under the universal health coverage scheme. This scheme serves as a mechanism for a sustainable response in key populations and community-led health services. While Thailand has seen a reduction in HIV and other blood-borne diseases in target populations, men having sex with men and people who use drugs still face relatively high rates of hepatitis C. The drug of choice, amphetamine type stimulants, poses challenges, with limited harm reduction interventions for these groups. Thailand remains committed to capacity building and evidence-based harm reduction interventions for these hard-to-reach populations. The country is open to learning from other nations and welcomes support in addressing these challenges.

Czechia: Let me build upon this morningdiscussion by emphasizing the critical importance of supporting the availability of services and care for people who use drugs. It is particularly essential to construct drug policies based on a harm reduction approach. This approach is aimed at reducing the risks and harms associated with drug use, benefiting both individuals and society as a whole. The persistently high prevalence of blood-borne infections among people who use drugs remains a significant concern. Injecting drug use continues to be a major factor in the global spread of HIV, hepatitis C and other blood-borne infectious diseases. It’s important to recognize that the transmission rates of HIV and hepatitis C are not gender-neutral. Women are more likely to be exposed to higher risks of sexual transmission of these infections, often exacerbated by factors such as sex work, increased vulnerability to abuse and a higher likelihood of being victims of physical assault or rape. Additionally, the MSM (men who have sex with men) community may also be at greater risk. According to the recent UNAIDS report from this year, laws criminalizing key populations or their behaviours remain in effect worldwide. The majority of countries, totalling 145, still criminalize the use or possession of small amounts of drugs. Additionally, 168 countries criminalize some aspects of sex work, 67 countries criminalize consensual same-sex intercourse, 20 countries criminalize transgender people, and 143 countries enforce laws against HIV exposure, non-disclosure, or transmission. Notably, the prevalence of HIV is seven times higher among people who inject drugs. Despite this, adequate funding for treatment remains insufficient. Recently, there have been some positive developments. The period from 2020 to 2022 witnessed an increased uptake in harm reduction interventions. Unfortunately, these efforts are still insufficient to meet the goals outlined in the 2030 Agenda for Sustainable Development. It is important to recognize that we have ample scientific evidence guiding us on how to proceed. This knowledge is crucial for reducing the risk and rate of transmission of HIV, hepatitis C virus, and other blood-borne infectious diseases globally. According to the most reliable available scientific evidence, a range of effective harm reduction interventions and services can significantly decrease the risks associated with drug use, including blood-borne infectious diseases and overdoses. In the Czech Republic, several of these measures are readily available. These include needle and syringe exchange programmes, naloxone programmes, opioid agonist therapy, a pilot programme for drug consumption rooms, as well as testing for blood-borne infectious diseases and free condom distribution programmes. We are also exploring additional measures to align our drug policy more closely with harm reduction principles. Unfortunately, many of these fundamental interventions are still lacking in most countries around the world. We should pay extra attention to children, youth, women and people in vulnerable situations, who are at a higher risk of developing drug use and mental health disorders. 3. Ladies and gentlemen, I would conclude by emphasising that we must persist in mainstreaming harm reduction policies based on the best available scientific evidence. These policies should be incorporated into our national, regional and global strategies. Moving forward with this approach is essential to ensure the well-being of both individuals and our societies. Thank you ladies and gentleman for your attention.

South Africa: Thank you, Mr. Chair. My delegation appreciates the presentations today and welcomes the opportunity to contribute to this discussion. We believe that addressing the challenges discussed is a shared responsibility of all UN member states, requiring an integrated approach involving human rights, health, and law enforcement. South Africa has adopted and is implementing the National Strategic Plan for Tuberculosis (TB) and Sexually Transmitted Infections (STIs) for the period 2023 to 2028, along with national guidelines for the management of viral hepatitis, to complement the National Drug Master Plan. These initiatives prioritize people and communities, emphasizing people-centered health care and social services in collaboration with partners, including the UN ODC regional office. South Africa is committed to achieving universal health coverage and responding comprehensively to the demands of prevention, treatment, and support, leaving no one behind. Gender mainstreaming is integral to these interventions. The strategy has led to the rollout of packages for people who inject drugs, encompassing HIV prevention, screening, testing, and treatment, as well as viral hepatitis prevention, screening, and treatment, including medicated-assisted treatment. Currently, opioid agonist treatment is available in the private sector, and efforts are underway to implement it in the public sector. In conclusion, South Africa continues to invest in harm reduction programs to address the needs of its population. Harm reduction sites have been established across the country to strengthen families and communities as the first line of response in care and support for affected groups.

Russia: Ladies and gentlemen, first of all, I would like to express gratitude to all the presenters for their valuable insights and for speaking on behalf of the Minister of Health. I would like to share some experiences related to HIV infection among people who use drugs or individuals with substance use disorders. In our country, individuals with substance use disorders are granted rights, freedoms, and access to comprehensive medical care. It is crucial to emphasize that they enjoy equal access to health and social services available to the general population. Simultaneously, the approach is based on harm reduction principles. We recognize the importance of a comprehensive approach, understanding that a one-size-fits-all strategy does not work in international relations. Countries have diverse contexts and are consistently developing strategies with a particular emphasis on capabilities and intentions. I would like to highlight that Russia, as one of the countries, has been actively working towards coverage in various ways, especially in its approach to addressing addiction. Recent federal regulations in Russia have reinforced a comprehensive approach that combines and integrates various aspects of care. This approach emphasizes the importance of consistent and continuous support, reflecting a person-centered perspective.

China: Thank you, Mr. Chair. First of all, I would like to express our appreciation for the insightful presentations given by colleagues, which were both interesting and informative. Allow me to share some of the strategies that China has implemented to address challenges related to reducing infectious diseases, such as HIV, associated with drug use. In 2004, China introduced community-based methadone maintenance treatment (MMT) and needle exchange programs for drug users. The government encourages individuals with severe drug use disorders to voluntarily undergo MMT, supported by national funds. This approach has significantly reduced the harm caused by drug abuse, including HIV and hepatitis. Presently, there are 782 MMT clinics nationwide, serving nearly 50,000 opiate drug users through daily medication. The proportion of new HIV infections among users undergoing MMT has seen a substantial decrease, dropping by 30 times from 0.95% in 2006 to the current rate of 0.03%. China has actively promoted cleaner needle programs, leading to a significant reduction in the proportion of HIV infections among drug users through injection. Since 2016, there have been no recorded cases of HIV infection due to injection drug use. To address issues related to employment and registration assistance for individuals undergoing drug treatment, China has implemented comprehensive governance involving multiple sectors, requiring collaboration between drug control, health, and various other departments. We welcome the CND and relevant international organizations to share timely and effective experiences in addressing drug-related problems and ensuring the well-being of populations.

Mexico:  Thank you, Mr. Chairperson. My delegation would like to express our appreciation for the presentations made in this session and for the opportunity to participate. We note with concern the inadequacy of continuing commitments related to this issue, particularly highlighting the unfulfilled commitment made in 2014 to reduce the transmission of HIV among injecting drug users by 50% by the year 2015. This commitment remains urgent, and we have not achieved the set goals by 2023. In addition, we request UNODC to provide an update to CND on their cooperation with WHO, UNAIDS, UNDP, UN Women, and other relevant agencies in addressing the incidence of HIV/AIDS and other blood-borne diseases among injecting drug users, including those in prison settings. We seek information on efforts made in line with commitments, such as those outlined in the political declaration of 2009 and the plan of action of 2019, to ensure that prevention, treatment, rehabilitation, and related support services consider and address these issues. Regarding cooperation with UNODC, WHO, UN, and other international and regional agencies, we express concern about any efforts to block collaboration, emphasizing that such actions are unacceptable to Mexico. We conclude by asking UNODC and WHO for an update on efforts to prevent the transmission of HIV, viral hepatitis, and other blood-borne diseases associated with drug use, particularly within broader harm reduction or diversion measures. Specifically, we seek information on the joint technical guide for countries to set targets for universal access to HIV prevention, treatment, and care for injecting drug users, with updates that reflect developments in medicine and changing trends in drug use. Thank you for the opportunity.

Austria: Thank you, Chair. I’m pleased to see you back in the chair and welcome back to Vienna. I want to express my appreciation for the Secretariat’s excellent preparation for these thematic discussions. In response to Questions 1 and 4, specifically addressing challenges related to increasing access to HIV and hepatitis C prevention, treatment, care, and support among people who use drugs and people with substance use disorders, I’d like to share information provided by the Austrian Federal Ministry of Social Affairs within the context of the survey for the UN Human Rights Council Special Rapporteur on the highest attainable standard of physical and mental health. We find agency cooperation crucial and value the information shared. For Question 1, we highlight good practices in Austria related to harm reduction efforts. Austria’s addiction prevention strategy serves as the foundation for these efforts. Various locations in Austria offer free HIV and hepatitis testing, vaccinations, and information campaigns for drug users. Syringe exchange and infection protection equipment are available across the country, including through vending machines and outreach services. From 2014 to 2020, the number of syringes provided decreased from 5.1 million to 4 million, reducing health risks for those who inject drugs. Austria maintains a National Early Warning System and a federal drug forum to exchange information on harm reduction projects, including temporary laboratories, drug test kit distribution, and research projects. For Question 4, we share good practices in addressing prison populations. Austria adheres to the principle of equivalence of care, ensuring that individuals in detention facilities receive the same quality of treatment as those outside. About 10% of inmates receive opioid substitution treatment, recently extended to include subcutaneous injection. We support a balanced approach with a focus on harm reduction, recognizing drug addiction as an illness best addressed through medical and social interventions. We commend UNODC’s efforts and encourage enhanced cooperation with WHO to identify good practices on harm reduction. We look forward to reports by the Commissioner on Human Rights and the specialist on drug policies and responses in March and June, respectively. As we approach the midterm review of the UNGASS, we appreciate UNODC’s collaboration and Director Ghada Waly’s efforts in promoting the organization’s important work in various UN fora. We acknowledge UNODC’s contribution to the implementation of the Sustainable Development Goals and other UN processes. Thank you.

France: Thank you. In September 2022, the French President reaffirmed that 56% of the responsibility for mobilizations was attributed. This pertains to the recalibration of global efforts in combating AIDS, Tuberculosis, and Malaria. A commitment of one point is made to rationalize the scale systems, amounting to 1.6 million for global considerations, including a 20% allocation for the initiative, and 250.55 million for disbursement from 2023 to 2025. Since its inception in 2011, the French program supporting global initiatives has been instrumental in financing actions and projects, addressing contradictions and honoring numerous commitments in the field, with a focus on over 32 million individuals over 12 years. Notably, financial and technical assistance is provided to support the Ministry of Health in the preparatory phases of introducing strategic plans, aligning with the National strategy and addressing public health issues related to harm and addictions.

Algeria: This section addresses the global public costs associated with sensitive audio rescues, including victim transmission and the heightened risk of overuse, potentially leading to the sharing of contaminated materials such as syringes and needles. The prevalence of injection drug use has increased, posing a significant challenge to public policy. Structuring ethical drug use is crucial, given its strong association with the increased risks of transmitting diseases such as HIV, hepatitis C, hepatitis B, septicemia, pertussis, and local bacterial infections. A holistic approach to preventing injection drug use and its associated risks involves educational campaigns, reduction and treatment measures, increased awareness, access to safe transmission and rehabilitation facilities, mental health care services, community interventions, legislation, and data collection. International cooperation plays a key role, focusing on consistent practices such as the use of sterile equipment and access to harm reduction programs to significantly mitigate the risk of disease transmission. Additionally, medical treatment and follow-up are deemed crucial for those already affected.

Algeria: Since this is my first time taking the floor I’d like to congratulate you for chairing this session. I’d like to thank you an Odyssey with regard to intervention of NGOs in the morning session like from Cochin who spoke under the umbrella of NGOs, Committee on drugs. We appreciate the interest of NGOs and support their work on but at the same time we try to clarify that it is information need to be updated is working hard to combat and cooperation with partner on UN Odyssey. Thank you for your attention.

Canada: Mr. Chair, in Canada, people who inject drugs face an elevated risk of HIV and hepatitis C transmission, with 85% of new hepatitis C infections attributed to injection drug use. Our nation has implemented a five-year action plan on sexually transmitted and blood-borne infections from 2019 to 2020. This plan focuses on reaching the undiagnosed, enhancing testing accessibility through culturally safe community-led models, deploying supportive technology, and ensuring the availability of new testing technologies. The 2024-2023 Action Plan builds upon these objectives, emphasizing access to prevention, treatment, and care in priority areas, alongside robust harm reduction services and diverse testing modalities. Canada is committed to person-centered, trauma-informed care that is linguistically and culturally relevant, and recognizes and supports peer-based approaches. Our funding extends to community-based programs providing services and care for people who use drugs and have contracted STIs. Notably, initiatives like a person-centered pilot project for indigenous HIV-positive individuals exemplify our commitment. Canada also addresses gender disparities, supporting women-only supervised injection sites. Peer outreach activities are instrumental in delivering culturally safe and stigma-free harm reduction services. Needle exchange programs, supervised consumption sites, and prison-based services contribute to HIV and hepatitis C prevention, treatment, care, and support. Despite disruptions due to the COVID-19 pandemic, Canada remains committed to facilitating access to vital services, particularly for populations at greater risk. We look forward to learning from international partners to enhance our approach. Thank you.

USA: The United States remains resolute in its commitment to collaborate with global partners to address ongoing challenges related to HIV, viral hepatitis, and other infectious diseases among people who use drugs. In the United States, the sharing of syringes and equipment during injection drug use continues to be a significant route for HIV and viral hepatitis transmission. Over the past two decades, the surge in synthetic opioid use and the resurgence of stimulants have led to an increased prevalence of injection drug use, resulting in health and social consequences. Reported cases of acute hepatitis C have doubled since 2014, with rising cases of HIV and other hepatitis infections. The U.S. responds to these challenges through historic investments in evidence-based prevention, harm reduction, treatment, and recovery support services. Expanding access to syringe services programs is a key aspect of our response, backed by three decades of compelling evidence regarding their effectiveness, safety, and cost-effectiveness. The U.S. has launched initiatives such as the Ending the HIV Epidemic Initiative and a five-year program to eliminate hepatitis C. These initiatives aim to reduce new infections and significantly expand screening, testing, treatment, prevention, and monitoring. While challenges persist, the U.S. remains equipped to address complex health issues and continues to make progress through a multi-sectoral and multi-stakeholder approach, grounded in compassion, dignity, and respect. Thank you.

Australia: A longstanding priority for Australia has been making significant progress in addressing communicable diseases, including those associated with drug use. Our commitment extends to actively contributing to global responses, aligning with various aspects of the sustainable development agenda. Australia proudly collaborated with Namibia in 2021 to co-facilitate the political declaration on HIV/AIDS at the UN General Assembly high-level meeting. This ambitious declaration emphasized human rights, science, health promotion, and addressing inequality and stigma in the HIV response. Applying these principles, along with considering broader social and structural determinants of health, is crucial for prevention, treatment, care, and harm reduction efforts not only for HIV but also for hepatitis C and other blood-borne viruses associated with drug use, particularly among people who inject drugs. Australia is committed to collaborating with global partners on these matters. In 2022, we initiated a multi-year partnership with UNAIDS and committed funding to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Direct support is also provided to Pacific and Southeast Asian countries for communicable disease prevention, treatment, and control. Australia’s strong national policy framework underpins our prioritization and commitment to addressing communicable diseases. This framework, including national strategy documents, addresses the impact of hepatitis B, hepatitis C, HIV, and blood-borne viruses. Harm reduction is a common principle across Australia’s strategies, aiming to minimize the adverse health and social impacts of drug use. Evidence supports the effectiveness of harm reduction approaches, such as needle and syringe programs, safe injection facilities, education and awareness programs, and drug treatment services. Priority population groups, including people who inject drugs, are identified across national strategies. Australia acknowledges that more needs to be done at local, regional, and global levels to sustain progress and achieve elimination targets. In closing, Australia reaffirms its commitment to accelerating action towards the Sustainable Development Goals, particularly targeting the end of the global AIDS epidemic and achieving the 2030 Global Hepatitis elimination targets. We embrace opportunities for collaboration and coordination across the UN system with other Member States, United Nations entities, international organizations, civil society, communities, and other relevant stakeholders. Thank you.

Colombia: I’d like to take this opportunity to describe what Colombia is doing. The most recent prevalence study examined HIV, viral hepatitis, and other diseases among people who inject drugs in cities like Santiago de Cali, Ada, and others. The results revealed variations in injection practices, sexual behavior, and changes in the demographic profile of the population. The study was a wake-up call for Colombia, with a threefold increase in HIV from 4.4% in 2012-2014 to 11.2% in 2021. In Cali, there was a substantial rise from 2.2% to 23.09%. These concerning measurements prompted the government to address the issue with a new policy. The policy aims to reduce barriers to access treatments for HIV, viral hepatitis, tuberculosis, and provide Naloxone and methadone. Implementation includes pharmacy and community dispensation models, ensuring quality comprehensive and integrated care for individuals with problematic drug use. Expanding and diversifying service offerings, reducing access barriers, and enhancing service relevance through inclusive and differentiated approaches are top priorities. The policy emphasizes humanizing and expanding service delivery devices, such as residential facilities, hospitals, ambulatory services, and mobile units. Community-based actions with differential ethnic, territorial, and gender-sensitive approaches are also implemented. The policy represents interventions across rehabilitation therapies, community models, and other programs providing treatment alternatives during imprisonment to ensure continuity of care. Colombia’s response to the increased prevalence of these diseases among drug users is a national effort. However, we raise a recurring question in this multilateral forum — if people are arrested for personal drug use, stigmatized for carrying needles, or forced into treatment against their will, how effective can our efforts be? The spirit of prohibition veils comprehensive production efforts, posing a post-colonial view challenge. As we discuss this topic, the question remains: How many more individuals must suffer before policymakers notice and decide to overhaul failed international drug policy? Thank you.

Human Rights Advisor to UNODC: Thank you very much. The UN Secretariat collaborates closely with co-sponsoring UN ODC and others to support governments, community-led organizations, and others in implementing commitments from the political declaration on HIV/AIDS and the global AIDS strategy. This support includes monitoring, technical assistance, advocacy, and thought leadership. Today, I’ll touch on the monitoring side, as well as advocacy and thought leadership. Over the past five years since the political declaration in 2019, not much has changed for people who use drugs regarding HIV. Globally, we’ve witnessed a 38% reduction in HIV infections since 2010, but from 2019 to 2021, there’s no evidence of appreciable change. In regions focused on people who inject drugs, HIV incidence has risen significantly, with prevalence around seven times higher than the rest of the adult population. In countries with disaggregated data, the range is from close to zero to 51%, showcasing both possibilities and challenges. Despite global strategies and political declarations emphasizing enabling social legal environments, decriminalization, discrimination reduction, and increased access to harm reduction services, progress remains insufficient. Around 60 countries are pursuing some form of decriminalization, but creative approaches often amount to punitive measures. Compulsory detention, parental custody loss, and disqualification from antiretroviral HIV treatment persist in many countries. Fines replacing prisons also contribute to disproportionate punishment. Stigma, discrimination, and violence against people who use drugs remain prevalent, with 30% reporting stigma and discrimination in the past six months and 28% experiencing violence in the past year. Harm reduction efforts face challenges, with approximately 100 countries not providing legal instruments and maintenance therapy. Despite a 50% target for needles and syringes coverage, only around 18% is achieved. Community-led initiatives, despite some successes, fall short of the 30% testing and treatment and 80% prevention services delivery targets. Involvement in HIV policy development and decision-making processes is insufficient, hindering progress in countries where HIV incidence is stagnant or increasing. Less than 1% of HIV funding specifically targets populations, and available resources are only 2% of what’s needed. To meet the 2030 target, annual resources needed for people who inject drugs in low and middle-income countries amount to $2.7 billion, while the reported spending on harm reduction last year was only $58.2 million, 2% of the required amount. Realistic and honest discussions and the support of the CMD are crucial for course correction. Technical support to countries is needed for early intervention. Thank you.

Policy Advisor to the UNODC: I appreciate the opportunity to address this crucial thematic session. Presently, around 296 million individuals globally use drugs, and the concern is rising, particularly among young people in Africa. The criminalization of drug use significantly contributes to the spread of HIV, impacting 1.6 million individuals who inject drugs, equating to one in every eight people living with HIV. In 2022, the global prevalence of HIV among adults who inject drugs was seven times higher compared to the general population. The use of stimulants and synthetic opioids heightens the risk of HIV transmission, while hepatitis C poses a substantial global health burden, affecting approximately 58 million people worldwide, with 1.5 million new infections annually. Notably, one-third of all hepatitis C-related deaths globally are attributed to injecting drug use. Access to hepatitis C treatment is hindered not only by high costs but also by legal and structural barriers, coupled with stigma and discrimination against people who use drugs. Addressing these pressing issues necessitates adopting evidence-based, human rights-centered approaches to policy. The UN system’s stance on drugs amid the COVID-19 pandemic calls for partnerships prioritizing these principles. International guidelines and human rights policies, collaboratively developed by UNDP and the University of Assets Adored, offer a roadmap for action. Noteworthy positive impacts have been observed, such as the implementation of the Housing First project in Brazil. Recognition by entities like the UN Human Rights Council, the European Union, and the Council of Europe underscores the significance of these guidelines. They stress the need to repeal or amend laws hindering access to controlled substances for medical purposes and harm reduction services. Emphasizing international human rights law, including the right to housing and non-discrimination, these guidelines advocate for voluntary access to harm reduction services, facilities, and information. Decriminalization and rights-based health approaches are emerging globally, from Thailand to Mexico, Switzerland to Colombia, signifying progress, albeit gradual. To effectively address global issues, including those related to HIV, we need a collaborative partnership at UNDP. Our commitment to policy aligns with partnerships on the SDGs. Let us unite to align our control mechanisms with health and development priorities, making a meaningful impact on the lives of people and communities, ensuring no one is left behind.

UN Women:  One-third of all people who use drugs are women, and this proportion is increasing. Despite limited sex-disaggregated data, available information suggests that women who inject drugs face a greater relative vulnerability to HIV, hepatitis C, and other blood-borne infections compared to men. In 30 countries reporting data, the pooled HIV prevalence among women was 13%, compared to 9% among men. Women’s heightened risk and vulnerability are exacerbated by punitive drug policies, creating intersecting injustices. Women who use drugs encounter challenges in realizing their rights to health and safety, experiencing stigma from families and communities, acting as barriers to reliable information and support. Gender-based violence is estimated to be two to five times higher among women who use drugs, leading to needle and syringe sharing, inconsistent condom use, fatal overdoses, and limited access to harm reduction and HIV/STI prevention. Service providers often remain gender-blind to factors increasing health risks for women who use drugs. Addressing these barriers requires gender-responsive, rights-based, and intersectional approaches to harm reduction, drug use, health, and HIV. Here are five areas to prioritize: Consider women’s overlapping identities and diverse lived experiences to understand the challenges they face and prioritize solutions for responsive women’s health. Invest in sex and age-disaggregated data and gender analysis to monitor and address the impact of discrimination towards women who use drugs. Develop flexible and comprehensive approaches that cater to the specific needs of women who use drugs, integrating gender-based violence and sexual/reproductive health services into harm reduction and HIV prevention efforts. Prioritize reforming discriminatory laws and practices that marginalize women who use drugs and hinder their access to HIV services. Recognize the importance of women’s leadership, ensuring meaningful involvement in decision-making processes that affect their lives and well-being. Women’s leadership, gender-responsive research, policies, and multi-sectoral approaches are vital for addressing priorities identified by women themselves and achieving the SDGs. UN Women stands ready to support these efforts. Thank you.

VNGOC // ?:  I am representing an NGO focused on drugs and HIV. The persistence of HIV among vulnerable populations, especially people who use drugs, underscores the significance of our approach. Screening, diagnosis, and treatment play crucial roles in making progress.Our programs in Greece and Portugal prioritize HIV management among patients who use drugs. The mobile outreach program serves as a priority intervention, conducting screening for drug-related infectious diseases, including HIV. The approach incorporates health education strategies to promote health literacy and combat the stigma associated with drug-related infections. Our case managers and monitors, working in the mobile outreach program, emphasize linking clients to treatment services and facilitating medication adherence. The data, derived from medical charts spanning 2001 to the present, indicate that over 8,000 service periods have been completed, with an average incidence rate of 2% and a prevalence of 21%. Notably, the prevalence has decreased steadily from 27% in 2003 to 14% in 2021. Over the last five years, the program has provided an average of 160,000 needles and syringes and 30,000 condoms annually. In conclusion, these results underscore the importance of mobile outreach programs in HIV screening and referral. Since 2001, our needle exchange program, coupled with investment in harm reduction education, has aimed to serve all individuals, irrespective of their legal status, emphasizing the monitoring and referral of specific groups among people who use drugs for specialized care in drug-related infectious diseases. Thank you.

VNGOC // INPUD:  I’m here as the executive director of the International Network of People Who Use Drugs, the global peak body representing the voices of people who use drugs. It’s crucial to recognize that people who use drugs are disproportionately affected by HIV, hepatitis, and other blood-borne viruses. This global health challenge necessitates addressing not drug abuse itself, but the structural barriers hindering access to necessary tools for protection. The sustainable approach to countering the pandemic is through social control, ensuring widespread access to harm reduction measures for people who use drugs. Unfortunately, only five countries provide high coverage harm reduction. Long-term recovery is not the sole solution to HIV, hepatitis C, and other related infections, contrary to the fallacy discussed during the 2020 intersessional. Denying individuals access to harm reduction tools based on their location or identity is unjust. Women, in particular, face unique barriers and challenges, including non-tailored services and intersectional stigma. A recent multi-stakeholder consultation highlighted the lack of funding and criminalization as contributors to health and social inequities. There is a substantial funding gap for harm reduction in low and middle-income countries, hindering efforts to combat HIV, hepatitis C, and blood-borne infections. High transmission rates persist when people are arrested for possessing needles, and harm reduction services are subjected to police raids and monitoring. The current prohibitionist paradigm, with $100 billion annually spent on the war on drugs versus $31 million on harm reduction, has failed to address the root issues. As we approach the midterm review, states are urged to be bolder and more honest in acknowledging the failures of the current approach. Decriminalization and inclusion in decision-making processes are essential. People who use drugs understand what works and what good practice entails, as many policy and service innovations during COVID emerged from our longstanding advocacy. Removing legal and funding barriers to participation will create effective systems and models to combat current and future pandemics. Thank you.

Speaker:  Thank you very much, esteemed delegates. This week has been enlightening, and as we’ve discussed throughout the day, the challenge of transmission rates for HIV, viral hepatitis, and other blood-borne diseases among people who use drugs and those in prisons is substantial. For instance, 10% of new infections occur among people who inject drugs, despite their representing only a small portion of the global population. Commendably, more countries are adopting harm reduction interventions, defined by WHO and us as including needle and syringe programs, opioid agonists, and Naloxone for overdose prevention. However, progress remains insufficient to impact HIV and hepatitis epidemics among these populations, especially considering the vulnerability of these programs to policy changes, funding challenges, and emergencies. Prison settings lack these essential public health interventions, leaving individuals susceptible to health risks when encountering the criminal justice system. Evidence shows that countries implementing such services at scale experience zero HIV transmission rates, emphasizing the need for broader implementation. Notably, there is a lack of harm reduction services tailored to the specific needs of young people, who face higher average risks of acquiring HIV and HCV. It is crucial not to leave women, young people, or drug users behind when implementing services. Meaningful empowerment in the design, implementation, and monitoring of policies and programs, as outlined in the 2021 political declaration on HIV, is paramount. The targets include reducing stigma, discrimination, gender inequality, violence, and legal barriers to access services. Moreover, criminalization of drug use for personal reasons impedes safe access to health and social services. It contributes to prison overcrowding, exacerbating health risks for those incarcerated. Implementation of laws and policies is as important as their creation, and our work involves collaborating with law enforcement to build capacity for a constructive response to HIV among drug users. Funding for harm reduction interventions and prison health programs is inadequate, especially in low and middle-income countries, where most funding comes from external donors. Community leadership remains key, and we have undertaken initiatives such as addressing gender-based violence among women and diverse gender identities and expressions among drug users. In addressing emergencies, our experiences emphasize the need for flexible funding approaches, community-led solutions, and technology use to ensure proximity to services. Vulnerable populations, including women, children, persons with disabilities, and incarcerated individuals, require targeted attention. The ongoing war in Ukraine underscores the challenges, but our community-led approach has yielded positive outcomes, reaching thousands with legal and social support. I want to express gratitude to our flexible donors, Germany and France, for their support. In conclusion, flexibility, community engagement, and sustained funding are crucial for effective responses to the challenges we face. Thank you for this opportunity to share our experiences and insights.

Chair: (Summary of session). Thank you for today. Meeting adjourned.

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